Abstract
Zusammenfassung.Zielsetzung: Übersicht über Suchtpotenzial und andere Risiken von Opioidanalgetika im höheren Lebensalter. Methodik: Narrativ review. Literaturrecherche in PubMed (Suchbegriffe: opioid analgesics UND abuse; opioid analgesics UND dependence; opioid analgesics UND addiction; opioid analgesics UND adverse effects; jeweils UND elderly) sowie aktuellen einschlägigen Standardwerken; Auswahl nach altersmedizinischer Relevanz und Aktualität. Ergebnisse: Die Verordnung von Opioidanalgetika (OA) hat in den letzten 25 Jahren massiv zugenommen, die weitaus meisten Verordnungen entfallen auf alte Menschen und Menschen mit chronischen Nicht-Tumorschmerzen (CNTS). Die diagnostischen Kriterien für die Opiatabhängigkeit in ICD-10 und DSM-5 sind für die OA-Behandlung von CNTS ungeeignet. Bei langfristiger OA-Behandlung bei CNTS kann eine spezifische Form von Abhängigkeit entstehen, die nicht mit der illegalen Opiat-(Heroin-)Sucht gleichzusetzen ist. Vorbestehende Suchterkrankungen und andere psychische Störungen sind die wesentlichsten Risikofaktoren. Weitere Nebenwirkungen sind zu beachten. Schmerztherapie bei Suchtkranken stellt eine besondere Herausforderung dar. Schlussfolgerungen: Die Anwendung von OA bei CNTS verlangt eine sorgfältige Indikationsstellung. Die besondere Form der Abhängigkeit von OA ist nicht ausreichend erforscht und wird zu wenig beachtet.
Abstract.Objective: To review dependence liability and other adverse effects of prescription opioid analgesics (OA) in old age. Methods: The author employed a narrative review and did a literature search in Pub Med (terms: opioid analgesics AND abuse; opioid analgesics AND dependence; opioid analgesics AND addiction; opioid analgesics AND adverse effects; in each case AND elderly) as well as in more recent relevant textbooks. Selection was made with respect to salience from a geriatric veiwpoint and topicality. Results: Prescription of OA has dramatically increased over the past 25 years, and by far most prescriptions are among the elderly and for chronic nonmalignant pain (CNTS). The diagnostic criteria of ICD-10 and DSM-5 do not sufficiently cover the specific problems of OA use in CNTS. Here a specific kind of dependence may occur that cannot be equated with street addiction to heroin. Preexisting substance use disorders and other mental disorders are the most important risk factors. But other adverse effects must be considered. Pain treatment in substance use disorders means a certain challenge. Conclusions: It is mandatory to thoroughly determine the indication for OA treatment in CNTS. This specific kind of OA dependence has to date been scarcely noticed, and there is only insufficient research on it.
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